Transcervical Endoscopic Esophageal Mobilization And Transhiatal Esophagectomy a Single Center Experience
Carlos O. Encarnacion1, Ahmed Ali2, Paul Dyrud2, William Tisol3, Mario Gasparri2, George B. Haasler2, David W. Johnstone2.
1University of Maryland, Baltimore, MD, USA, 2Medical College of Wisconsin, Milwaukee, WI, USA, 3Aurora St. Luke's Medical Center, MIlwaukee, WI, USA.
Minimally invasive esophagectomies are becoming more popular in the surgical armentarium of a thoracic surgeon. There are many different minimally invasive techniques employed by thoracic surgeons around the country. At our institution we have developed the transcervical endoscopic esophageal mobilization technique or TEEM. We sought to evaluate our clinical outcomes compared to those nationally to establish TEEM as a safe, oncologically sound operation for esophageal cancer.
After IRB approval a retrospective chart review was conducted for all TEEMs done from 2009 to December 2016. The surgical technique consisted of video endoscopic mobilization of the esophagus through a cervical incision and a standard transhiatial abdominal approach. The TEEM approach was carried out by all surgeons part of the thoracic surgery division.
There were a total of 167 patients (86% men) with a mean age of 62, and a mean BMI of 28.53 underwent TEEM esophagectomy. The average length of stay was 13 (+/- 0.60) days and our average ICU length of stay was 3 days (+/- 0.54). The mean intraoperative time was 180.8 minutes (171.7-189.9). Our leak rate was 8.5%. Only 10% of patients had vocal cord dysfunction at 6 month follow up. The 30 day, and 1-year survival probability respectively were 0.97 (CI 0.93-0.99) and 0.85(CI 0.78- 0.90).
TEEM esophagectomy is a safe minimally invasive approach to esophageal cancer. With increasing experience the TEEM approach can supplement other esophagectomy techniques.
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